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Yes , its OK to miss one day of meds , just don't make a habit of it . Did you forget a dose or is something else up ? ... if you don't mind me asking .

I wasn't able to go to the clinic for my refill of meds due to my hectic schedules at school and i ask the doctor's assistant if i could go and have my refill tomorrow , they told me that the clinic is not open at Sunday. I'm worried. THANKS for the infos.

yeah it does. can i develop resistance to the drugs if i missed 1 day dose of meds?

In a nutshell no ... you wont get resistance from missing a dose of meds once in awhile .Your goal should be to take at least about 95% of your meds so missing a dose is nothing to worry over .

I'm in a little over my head here giving you advice . I'm at a friends house on his computer and every time I try to open and copy a link I screw it up . I really don't like giving advice without backing it with some information and a link for you to read it yourself . If you look at the top of the page on the forum you can find lessons under treatment Tab ... this site has most of the information you will ever need to learn about these things . Sorry I couldn't be of more help .

yeah it does. can i develop resistance to the drugs if i missed 1 day dose of meds?

short and sweet, Nope.

do a google search on "95% adherence hiv", you'll find plenty of links to studies that show that having >=95% adherence keeps an optimal drug level in your system.

Why there's even a study on Atripla called FOTO (5 days on, 2 days off) that shows missing that much still works and now there are studies that show that with modern meds even LESS than 95% adherence still works - however >95% is still the recommended percentage

Does it matter if youre VL is Undetectable? Or for that matter how long you've been on meds?

does what matter?

the goal of successful HIV therapy is to reduce the HIV viral load to UD which should allow the immune system to recover cd4s above 200. Successful therapy usually gets people to that point within 6 months to a year. After that remaining adherent (>=95%) should maintain UD and perhaps allow the cd4s to rise more. Theoretically one should be able to remain on the same regimen maintaining UD for decades and decades.

CD4 rise itself is based upon what your pre-HIV cd4 level was (which most people have no clue about LOL) and how low your cd4s went. cd4s going very low often means they won't rise very high. (I hit lows of 5, 7,and 12 over a yr or 2, so it's no wonder it's taken me 20 yrs to barely hit 300 and not much higher)

in your situation JB, guidelines say that you can start meds when your cd4s start dipping around 500 and you for sure need to start meds by the time they drop to 350. You might be influenced to start earlier because of a high viral load or other side effects of the HIV itself.

I thought I had read somewhere or some post that when first starting meds that taking the med at or around the same time every day was crucial until you were undectable. Then once you were undectable, If you missed a dose it wasn't such a big deal?

I thought I had read somewhere or some post that when first starting meds that taking the med at or around the same time every day was crucial until you were undectable. Then once you were undectable, If you missed a dose it wasn't such a big deal?

the object to defeating HIV is to keep a certain level of medication in your system. When the level is too low, HIV can learn to beat the med and becomes resistant to that med. Therefore taking meds around the same time (within a few hrs) is a very wise way to make sure the level of med remains high enough - based on initial absorption, which is why some are with food and some without, and rate of depletion, how fast it spreads out in your system and how fast you excrete it (how much you lose in your urine).

Once you've reached UD and maintained that for a while (9mo to a yr) then maintaining >=95% is the low end of the goal. It's actually much better, and much easier, to aim for 100% adherence. Once you establish a pattern of taking meds - with a meal, in the morning, in the evening, using an alarm, using a pillbox, using a medication reminder app, whatever works for you - after a while this should become a habit (like after that first year of 100% adherence) so most people just continue on that way with only an occasional, rare dosage miss.

Missing a dose is actually quite a BIG deal as it's the start of a very BAD habit. Just take your meds as they are the only thing that fights HIV, and therefore the only thing that'll keep AIDS from killing you. (see how easy it is to stay adherent when you realize that non-adherence will be the death of you?? LOL )

Missing a dose is actually quite a BIG deal as it's the start of a very BAD habit. Just take your meds as they are the only thing that fights HIV, and therefore the only thing that'll keep AIDS from killing you. (see how easy it is to stay adherent when you realize that non-adherence will be the death of you?? LOL )

Nice bedside manner you got there Dr. Kervorkian. I doubt even his ID doc would put it in such stark terms. Everyone knows (including you) one missed dose will in no way put you on a habitually induced death spiral.

Everyone knows (including you) one missed dose will in no way put you on a habitually induced death spiral.

dach = failEven you should know that uncontrolled HIV leads to AIDS and that leads to death. I know that you, like I, have lived through the yrs of seeing your friends die from HIV/AIDS so lets not pretend that (untreated/improperly treated) HIV is not a terminal illness.

obviously you did not read this entire thread. Clearly, I NEVER said that missing one dose would be the end of anyone. maybe you should read through the google link I posted since it spells out how I explained that >=95% is what is needed. However, I was trying to emphasize the need to remain adherent, and to generally remain on meds, as HAART is the only thing to control HIV. Thinking that one can miss a dose here or there can be a bad mindset that can lead to bad adherence and uncontrolled HIV, so I emphasized that that kind of negligence could eventually lead to death.

dach = failEven you should know that uncontrolled HIV leads to AIDS and that leads to death. I know that you, like I, have lived through the yrs of seeing your friends die from HIV/AIDS so lets not pretend that (untreated/improperly treated) HIV is not a terminal illness.

obviously you did not read this entire thread. Clearly, I NEVER said that missing one dose would be the end of anyone. maybe you should read through the google link I posted since it spells out how I explained that >=95% is what is needed. However, I was trying to emphasize the need to remain adherent, and to generally remain on meds, as HAART is the only thing to control HIV. Thinking that one can miss a dose here or there can be a bad mindset that can lead to bad adherence and uncontrolled HIV, so I emphasized that that kind of negligence could eventually lead to death.

I beg to differ. I don't think there was anything wrong with what Doxy posted in response. You have to take into consideration here that the OP is obviously someone recently diagnosed and therefore most likely on his first regimen; otherwise, he wouldn't have posted with the level of concern about missing a dose of his meds.

YHPoz, and other treatment naive people on the forums, all strike me as being people who have no idea of what certain percentage adherence means, nor is it advisable to send them to a link of pages of journal articles from the last few years and expect them to understand the language contained within. I actually got the impression he was quite frightened that he would become resistant, because he posted another thread outlining that he wasn't able to get his meds in a timely fashion and was looking for a way for someone to lend him pills until he could get his scripts. That is not someone who understands hiv treatment completely.

Also many of these "newbies" are of the mindset that they will live to see a cure for this unfortunate, chronic manageable condition they are dealing with: that's obvious from the fact that they so willingly latch onto (and post) every single scrap of research/treatment studies that give them the false hope that somehow they will be able to eradicate that tragic mistake they made by contracting hiv, for whatever reason. I mean with a screen name like the OP's, isn't it obvious that he views hiv in a different light than someone who has been living with it since the olden times?

Doxy just made it plain for them to grasp the fact that if they miss one dose, then it's not the end of the world. That they won't die like they seem to think because the meds will stop working. Although you did convey that message to them, as well, you also have to be able to empathize and put yourself in their shoes and realize they don't know as much as you do because they haven't dealt with hiv for as long as you have.

Maybe instead of pushing 95% adherence, someone, like yourself, needs to explain in laymen's terms what that means and not direct these people to mumbo-jumbo statistical filled journals if you want to be really helpful. Information and explanation in plain language will go a long way in assuaging fears because knowledge is power.

Seroconverted: Early 80sTested & confirmed what I already knew: early 90s

Current regimen: Atripla. Last regimen: Epzicom, Sustiva (since its inception with NO adverse side effects: no vivid dreams and NONE of the problems people who can't tolerate this drug may experience: color me lucky )Past regimensFun stuff (in the past): HAV/HBV, crypto, shingles, AIDS, PCP

You have to take into consideration here that the OP is obviously someone recently diagnosed and therefore most likely on his first regimen; otherwise, he wouldn't have posted with the level of concern about missing a dose of his meds.

actually I was responding to someone that hasn't even started medication, not the OP. Since adherence is a huge issue with people new to medication, I felt it more important to stress total adherence as that is what the doctor will prescribe and expect. I had already pointed out to the actual OP that missing a dose (clearly within >=95% adherence) was still okay.

maybe you and Dach need to coordinate your arguements. While I was trying to stress that 100% adherence is the way to go for someone asking about initially starting medications, I started this thread by saying to the OP that if you fail 100%, staying above 95% is still okay. Dach jumps on me for supposedly saying it's 100% or death, and you are accusing me of "pushing" 95%. ROFL

Maybe instead of pushing 95% adherence, someone, like yourself, needs to explain in laymen's terms what that means and not direct these people to mumbo-jumbo statistical filled journals if you want to be really helpful. Information and explanation in plain language will go a long way in assuaging fears because knowledge is power.

How dare you think that people should do their own research over some trivial tidbit you dropped into this thread

so rather than just drop some tidbit into this thread without links to data backing up my comments (something you recently accused someone else of doing), I actually posted a link with many articles explaining so that even a layman could understand what 95% adherence means. Certainly I am not a doctor so the OP should not take my saying 95% at face value, so I provided links to plenty of real medical info so that the OP could learn more about HIV. Not knowing how often or how many meds the OP takes, I can't get any more specific that "95%". He'll have to do his own math for his own medication regimen to know exactly how many doses are in that range for him.

that's obvious from the fact that they so willingly latch onto (and post) every single scrap of research/treatment studies that give them the false hope that somehow they will be able to eradicate that tragic mistake they made by contracting hiv, for whatever reason.

YHPoz, and other treatment naive people on the forums, all strike me as being people who have no idea of what certain percentage adherence means, nor is it advisable to send them to a link of pages of journal articles from the last few years and expect them to understand the language contained within.

how utterly naive and insulting! Insulting to me and the OP (and others). First you fling accusations that people research too much and then you suggest that they can't even understand it when someone directs them to proper research.

How do you think I learned about HIV and related issues back in the 80s and 90s, and even into the 00s? Certainly not always through my doctors who knew the same or less than I did as we were all living through the crisis of this epidemic. And how did I, and others like me, learn this information? Through reading medical info just like I linked the OP to. How insulting to suggest that the OP can't comprehend journal articles the way you and I did, and the way we still do today.

Quote

Although you did convey that message to them, as well, you also have to be able to empathize

so although you accused me of pushing 95% (or was that threatening 100%? LOL), in the long run you can't criticize anything that I said as wrong; but your criticism is that I didn't say it in a way that you approved of? well, la dee da. Since none of my comments/responses were directed to you, then I can't say that your approval matters much. Maybe the OP isn't as dumb as you think he is and he understood just fine; or maybe if the OP didn't understand what >=95% means then he'll come back and ask more questions. But in deference to you, since Jeff only responded by saying the same 95% figure (without any backing data or links, just some tidbit he threw out there LOL), I'll let him answer any followup questions the OP might have.

By the way, Jeff clearly explained he wasn't able to post links. He didn't just "throw something out there" and referred the poster to the lessons at the top of this site.

yes, I clearly understood that. However, Solo seemed to neither have issues with Jeff just saying 95%, without explaining this to the "newbies", nor with Jeff not backing up his statement.

It seems Solo is very selective about what is posted and who posts it when it's not posted in a way that he approves of. I just don't see how I posted anything that much different from Jeff, although I was able to provide some links that Jeff wasn't able to, and yet Solo doesn't seem to have an issue with how Jeff posted to the "poor newbies who can't understand".

I just wrote what I did in a snarky way (which I should have implied better rather than hoping that people like you would infer) to point out the strange way Solo chooses what he does and doesn't like for the method of people posting on AM. Thank you for pointing that out so I could explain it better.

yes, I clearly understood that. However, Solo seemed to neither have issues with Jeff just saying 95%, without explaining this to the "newbies", nor with Jeff not backing up his statement.

It seems Solo is very selective about what is posted and who posts it when it's not posted in a way that he approves of. I just don't see how I posted anything that much different from Jeff, although I was able to provide some links that Jeff wasn't able to, and yet Solo doesn't seem to have an issue with how Jeff posted to the "poor newbies who can't understand".

I just wrote what I did in a snarky way (which I should have implied better rather than hoping that people like you would infer) to point out the strange way Solo chooses what he does and doesn't like for the method of people posting on AM. Thank you for pointing that out so I could explain it better.

You know what? I'm not going to give you the satisfaction of attempting to bait me in order to derail this thread. It's clear to see that you are attempting to start something and I can't be bothered with your antics.

Seroconverted: Early 80sTested & confirmed what I already knew: early 90s

Current regimen: Atripla. Last regimen: Epzicom, Sustiva (since its inception with NO adverse side effects: no vivid dreams and NONE of the problems people who can't tolerate this drug may experience: color me lucky )Past regimensFun stuff (in the past): HAV/HBV, crypto, shingles, AIDS, PCP

The nasty bites back and forth on here are honestly tedious. A simple question about missing a single damn dose of meds has led to ad-nauseum attacks that might make any normal person think twice about asking ANY question. In the words of the now "late" Rodney King, "can't we all get along"?

Logged

Diagnosed in May of 2010 with teh AIDS.

PCP Pneumonia . CD4 8 . VL 500,000

TRIUMEQ - VALTREX - FLUOXETINE - FENOFIBRATE - PRAVASTATIN - CIALIS

Numbers consistent since 12/2010 - VL has remained undetectable and CD4 is anywhere from 275-325

So we're pulling quotes from other threads on other subjects with completely different contexts because one upmanship and winning an argument is more important than providing the most beneficial answers.

Just making sure I'm still clear on what the real motives and values are.

do a google search on "95% adherence hiv", you'll find plenty of links to studies that show that having >=95% adherence keeps an optimal drug level in your system.

Why there's even a study on Atripla called FOTO (5 days on, 2 days off) that shows missing that much still works and now there are studies that show that with modern meds even LESS than 95% adherence still works - however >95% is still the recommended percentage

Your link, when clicked upon brings up the following:

None of which state in plain language that it is okay to miss a single dose of meds.

Instead those links are filled with abstract journals full of language such as the following:

RESULTS:

During the study period, 45,397 doses of protease inhibitor were monitored in 81 evaluable patients. Adherence was significantly associated with successful virologic outcome (P < 0.001) and increase in CD4 lymphocyte count (P = 0.006). Virologic failure was documented in 22% of patients with adherence of 95% or greater, 61% of those with 80% to 94.9% adherence, and 80% of those with less than 80% adherence. Patients with adherence of 95% or greater had fewer days in the hospital (2.6 days per 1000 days of follow-up) than those with less than 95% adherence (12.9 days per 1000 days of follow-up; P = 0.001). No opportunistic infections or deaths occurred in patients with 95% or greater adherence. Active psychiatric illness was an independent risk factor for adherence less than 95% (P = 0.04). Physicians predicted adherence incorrectly for 41% of patients, and clinic nurses predicted it incorrectly for 30% of patients.

Please explain to me how someone that is new to treatment (or hasn't started treatment) is supposed to understand this to mean that it is ok to miss a single dose? Maybe that info is contained in that FOTO study you alluded to, but didn't link to, unless it is hidden somewhere is this mess of links from Google.

I had no problem with you validating Jeff's response, it was just the fact that you sent an already worried person to something that was probably more overwhelming than necessary. So of course, since you are still looking for a fight, you chose to pick apart what I said; especially since you had to mention that I did something similar recently - despite the fact you constantly jump into a thread and force your "I know it all" attitude on everyone.

This is where I get off the train and leave you standing. I'm not the one who is struggling to elevate my CD4 count, 95% adherence rate or not.

Seroconverted: Early 80sTested & confirmed what I already knew: early 90s

Current regimen: Atripla. Last regimen: Epzicom, Sustiva (since its inception with NO adverse side effects: no vivid dreams and NONE of the problems people who can't tolerate this drug may experience: color me lucky )Past regimensFun stuff (in the past): HAV/HBV, crypto, shingles, AIDS, PCP

So we're pulling quotes from other threads on other subjects with completely different contexts because one upmanship and winning an argument is more important than providing the most beneficial answers.

no that's not quite right. I provided an appropriate, beneficial answer. Someone else decided that they didn't like the way I gave this answer even though in other threads they criticized people for not giving answers "appropriately" ( that is with backing links/data). I wasn't talking about the same context but about the same method.

I would say that I'm not certain what the motives and values are of some other people; but seeing exactly who has made disparaging comments about my posts, I am certain I understand their motives as we've all seen this before. As drewm said, it is quite tedious.

it was just the fact that you sent an already worried person to something that was probably more overwhelming than necessary.

wow. so providing links to scientific evidence that backs up a statement I posted is "overwhelming". Boy you sure have a low opinion of the intelligence of people you've never met - those same people you think "latch onto ... every single scrap of research/treatment studies".

Let me be clear ... I didn't post a link because I was on a buds computer who wanted to use it himself . The link I edited out of my post was one like solo mentioned , a bit too detailed and little to do with a simple question by an inexperienced new member who was very much upset . Its important to remember that the guy was upset and wasn't going to get his meds for a few days no matter how long we went on about it . I felt comfortable with the info I gave him and he seemed relieved as well .

We need to also keep in mind that posting walls of links for simple questions is not an absolute requirement . Asking someone for a link is a great way to politely say stop pulling facts out of your ass and back up with what your saying with science but in this instance my assurance and the info I provided was not in dispute . I answered because not many people were on line and he was in distress , not to feed my ego .

no that's not quite right. I provided an appropriate, beneficial answer. Someone else decided that they didn't like the way I gave this answer even though in other threads they criticized people for not giving answers "appropriately" ( that is with backing links/data). I wasn't talking about the same context but about the same method.

I would say that I'm not certain what the motives and values are of some other people; but seeing exactly who has made disparaging comments about my posts, I am certain I understand their motives as we've all seen this before. As drewm said, it is quite tedious.

Hmmmm....I stand by my original assessment. The context matters in relation to the method. And I refuse to believe that you don't grasp this. You do, but its importance comes in at a distant 2nd to your own personal glorifcation. I mean honestly what got me ticked about this was when you called Jeff into the mix, suggesting there was some sort of favoritism involved because he didn't include links in his post. He explained why and even verbally pointed the OP to further information. It was pretty cheap shot, in my opinion.

Dachs and Solo had a pretty fair point whether you care to acknowledge or not. I remember when I got started out on meds and had an accidental night where I was stranded without my pills. I was up into the night trying to find someone through phone and internet who could give me a dose. An answer like Jeff's would have set me at ease, whereas one like your's with a tidal wave of links with a "you'lll die if you don't" tag at the end would have had me up all night in fits. Your answer was technically "appropriate and beneficial", but Jeff's was better.

Of course, I already know you'll have none of what I just said and this will just keep going on and on and on, little winky sarcastic smiley faces and all. We have indeed seen it all before. And yes, it is tedious.